The Japanese journal of surgery最新文献

The immunohistochemical expression of DF3 antigen and serum concentrations of CA15-3, a breast carcinoma-associated antigen recognized by the monoclonal antibodies (MAbs) 115D8 and DF3, was investigated in breast cancer patients. The levels of serum CA15-3 in 23 primary breast cancer patients did not correlate to the percentage cytoplasmic reactivity of MAb DF3 with the carcinoma cells in tissue specimens from each respective patient. In 17 patients who subsequently developed metastatic breast cancer, however, the serum CA15-3 concentrations generally correlated well to the cytoplasmic reactivity of MAb DF3 with the carcinoma cells in specimens obtained at initial biopsy or mastectomy. Elevated levels of serum CA15-3 were seen in metastatic breast cancer patients when the carcinoma cells in their primary specimens expressed enhanced levels of cytoplasmic DF3 antigen. The results of this study suggest that the immunohistochemical demonstration of DF3 antigen in tissue specimens, together with the periodical measurement of circulating CA15-3 antigen, may be important for monitoring the clinical course of breast cancer patients.

We report herein a case of Peutz-Jeghers syndrome associated with an adenocarcinoma of the cecum and four focal cancers arising in hamartomatous polyps of the colon. There were a total 27 polyps in the intestine; 4 in the small intestine and the rest in the large intestine. The hamartomatous polyps in which the 4 focal cancers were found showed no component of adenoma, and the other polyps removed from the colon and small intestine at the same time were all hamartomas with no evidence of dysplasia or malignancy. This case was rare in that multiple focal cancers may have arisen directly from the hamartomous polyps of the colon.

A 5 year old girl who presented with two bluish, cystic masses in her right forearm was shown on ultrasonography to have two localized saccular dilatations of the right radial vein. This led to the suspicion of venous aneurysms which was later confirmed by venography. They were finally excised because of the gradual increase in size and pain she had experienced over the previous two months.

The removal of serum myoglobin with extracorporeal circulation using a column filled with methylmethacrylate-divinylbenzene (MMA-DVB) was studied in experimentally induced myonephropathic metabolic syndrome in the dog. All animals showed marked edema in the hind limbs and degeneration or necrosis of the adductor muscle 5 hours after the reestablishment of arterial flow. The serum levels of myoglobin, creatinine phosphokinase, glutamic oxaloacetic transaminase and aldolase increased linearly after the reperfusion of blood in the group of animals which received no extracorporeal circulation (group 1). Sediments of numerous myoglobin casts in the renal tubules and immunoreactive myoglobin in the renal epithelium of almost all the tubules were seen in 4 out of 5 cases. In the group of animals reperfused with extracorporeal circulation using the MMA-DVB column, serum myoglobin was adsorbed selectively by the column and showed a significantly lower value at 0.5, 1, 2 and 3 hours than that of the group 1 animals. Concomitantly, the immunoreactive myoglobin was absent or scant in the renal epithelium of the proximal convoluted tubule. The present study therefore indicates that extracorporeal circulation using the MMA-DVB column is useful for the removal of serum myoglobin from experimentally induced myonephropathic metabolic syndrome.

An unusual case of a 44 year old woman who developed a nonspecific ulcer of the sigmoid colon is reported herein. She presented with lower abdominal pain and fever and colonoscopy revealed a large, sigmoid colon ulcer with normal surrounding mucosa and a well-defined margin. A temporary sigmoidostomy was done to decompress the bowel content and, after the abdominal pain and fever had subsided, the involved segment with an ulcer of 6.1 X 2.5 cm was resected. Her postoperative course was uneventful and she has remained well since.

Oophorectomy was found to decrease the plasminogen activator activity of rat mammary tumors induced by 7,12-dimethylbenz(a)anthracene (DMBA) to less than 7 per cent, while in vivo estradiol treatment restored its activity in a dose dependent fashion. The peroxidase activity was not changed either by oophorectomy or by the administration of estrogen. In the rat uterus, plasminogen activator activity was not changed by oophorectomy or by the administration of estrogen, however, its peroxidase activity decreased to less than 2 per cent following oophorectomy, while estrogen administration restored its activity. Estrogen regulated plasminogen activator activity in the DMBA-induced rat mammary tumors but not in the uterus and thus, the specific hormonal regulation of this enzyme may be an important factor for the hormonal dependent growth of such tumors.

In order to suppress the host immune reaction in subrenal capsule assay (SRCA) using normal immunocompetent mice, the effects of cyclophosphamide (CPM) pretreatment were compared to those obtained after cyclosporine A (CSA) treatment. CPM and CSA suppressed the host reaction until day 6 and day 12, respectively, however, the histological evaluation of the tumors on day 6 revealed no differences between the two groups. The cytotoxicity of CPM in mouse serum against P388 cells was measured to evaluate the residual activity of CPM against the implanted tumor. No cytotoxicity was observed in the serum 36 hours after the CPM injection. In the histological analysis of clinical samples, inflammatory infiltration was observed in only 4 of 25 samples and tumor cell preservation recognized in 27 of 28 samples. A persistence of tumor cells was recognized in the samples rich in tumor cells. Adequate growth of the tumor in the control groups was obtained from 30 of 33 tumors (91 per cent), and the response rates of this assay were comparable to those of prior clinical experiences on each of these drugs. These results indicated the feasibility of SRCA with CPM pretreatment as a predictive test of chemotherapeutic agents for esophageal cancer.

Isolated perfused rabbit hearts were studied to compare the effects of 3 hour ischemic arrest following either calcium-free or calcium-containing cardioplegia, on the recovery of isovolumic function of the left ventricle, coronary flow, release of creatine phosphokinase and myocardial water content. The hearts perfused with the calcium-containing solution (Ca 0.5 mmol/L) showed better recovery of the developed pressure in the left ventricle, and its first derivative and compliance. Coronary flow at a constant perfusion pressure was better restored during reperfusion in the hearts with calcium-containing solution. The release of less CPK and a lower water content were also observed in the hearts reperfused with calcium-containing solution. We concluded that calcium-containing cardioplegic solution with a high concentration of magnesium (10 mmol/L) was superior to calcium-free solution for myocardial protection.

The long-term patient and graft survivals, causes of death, complications and rehabilitation status in the second decade were analyzed in 114 patients who received living related kidney transplants and were followed up for 10 years or longer. Azathioprine and prednisolone were used for basal immunosuppressive therapy in all patients. The actual patient and graft survival rates at 10 years were 76.3 per cent and 50.9 per cent respectively, the main causes of death being serious infection (10 cases), malignant disease (5 cases), cerebral bleeding (4 cases), hepatic failure (3 cases), gastrointestinal bleeding (2 cases) and cardiovascular disorder (2 cases). Four patients died from complications after re-admission for hemodialysis. The cumulative patient and graft survival rates at 15 years in 58 patients whose graft survived for over 10 years were 87 per cent and 75 per cent, respectively. Of the 51 patients still surviving at the end of the study, the complete rehabilitation rate was 90.2 per cent, however, de novo malignant disease and hepatic disorder were significant complications which not only disturbed the patients' quality of life but also reduced their survival rate. Therefore, regular follow-up of patients and appropriate management procedures are necessary to enhance the long-term success of kidney transplantation.

Of a total thirteen patients who underwent surgery for a neurogenic tumor in the posterior mediastinum 4 (30.8 per cent) presented with dumbbell type development of the tumor. Along with a comparatively greater incidence in the number of cases of dumbbell neurogenic tumors in the posterior mediastinum, resection has also recently become more popular, necessitating the establishment of a standard operative approach for this type of tumor. We successfully removed dumbbell neurogenic tumor from the posterior mediastinum in our 3 most recent cases via a dorsal approach by virtue of a laminectomy and resection of a small portion of the neighbouring rib root without opening the parietal pleura at all. These three patients were a 14 year old female, a 54 year old male and a 68 year old female, respectively, and the largest diameter in cm and level of origin of the tumors were 5.5 at Th 1 in case 1, 3.0 at Th 2 in case 2 and 3.7 at Th 11 in case 3. The operative approach described herein was easy to perform, felt secure and was less invasive and better tolerated by the patients than the thoracotomy approach. Avoiding a thoracotomy in such cases has many advantages to enumerate, but does not seem to have been clearly aimed at by others to date. We therefore propose our technique as a standard approach for dumbbell neurogenic tumors in the posterior mediastinum.